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This is the VOA Special English Economics Report.

Health care costs are a major concern of Americans. The percentage of people covered by private health insurance dropped last year. Yet more people had insurance than the year before.

A nurse helps a patient in the emergency room at Harborview Medical Center in Seattle

The Census Bureau says that was because of an increase in government health programs. Government programs covered eighty-three million people last year, about twenty-eight percent of the nation.

Federal and state programs insure older people, the poor and members of the military. But unlike other developed countries, the United States does not offer health insurance to all its citizens.

Forty-seven million people were uninsured in two thousand six. The Census Bureau says that number fell by more than a million last year. But experts predict that the current economic downturn will again raise the number of uninsured.

People buy health insurance to pay some or all the costs of medical care. But plans can be costly, and people with existing conditions may not be able to get coverage at all.

Yet even people with insurance may not have enough coverage to pay high medical bills. The Commonwealth Fund, a research group, says twenty-five million adults are underinsured. It says that is a sixty percent increase in five years.

The United States now spends more than two trillion dollars a year on health care. Health spending could represent one-fifth of the economy in less than ten years.

Republican presidential candidate John McCain has proposed tax credits to help pay for insurance. He also has ideas for ways to make health care more competitive and less costly. And he has called for a Guaranteed Access Plan to help get coverage for people who have difficulty getting insurance.

Democrat Barack Obama has a plan that he says would guarantee health insurance for all Americans. It includes a requirement to insure all children. He also proposes a National Health Insurance Exchange to make it easier to buy private plans or to continue coverage when changing jobs.

Sixty percent of Americans are insured through plans offered by employers. As costs increase, employers often have workers pay more for doctor visits and other services. The Mercer consulting company says employee cost-sharing has risen sharply over the past five years.

Early reports suggest that next year's cost increase for employers will fall below six percent, to the lowest growth in more than ten years.

And that's the VOA Special English Economics Report, written by Mario Ritter. I'm Steve Ember.